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Estreñimiento y cuidado intestinal después de la cirugía

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¿Por qué el tránsito intestinal suele ralentizarse después de una operación? Y qué medidas sencillas, en su mayoría evitables, pueden ayudar a mantenerlo en marcha, especialmente cuando se toman analgésicos fuertes.

Una puerta de baño cerrada con un cartel de aseo.
El estreñimiento es muy frecuente después de la cirugía, especialmente con analgésicos potentes; sin embargo, en gran medida se puede prevenir. Kieran Hirpara 4.0

Esta página se tradujo automáticamente y todavía no la ha revisado un médico. La versión en inglés es la versión oficial.

El estreñimiento es uno de los problemas más frecuentes que experimentan las personas después de una operación, y toma por sorpresa a muchos pacientes. La buena noticia es que es predecible, lo que significa que en gran medida se puede prevenir. Una pequeña planificación durante los primeros días, especialmente en lo referente a los analgésicos, suele ayudar a mantener el tránsito intestinal sin problemas.

¿Por qué la cirugía ralentiza el tránsito intestinal?

Después de una operación, varios factores actúan simultáneamente sobre el intestino:

  • Los analgésicos fuertes (opioides) son el factor principal. Medicamentos como la codeína, oxicodona, tramadol, tapentadol y morfina alivian bien el dolor, pero también actúan directamente sobre el intestino y lo ralentizan notablemente. Este es el motivo más importante. A diferencia de la somnolencia y las náuseas que estos fármacos pueden provocar (las cuales suelen desaparecer tras unos días), el intestino no se acostumbra a los opioides. La ralentización persiste mientras se sigan tomando, por lo que es necesario gestionarla de forma deliberada en lugar de esperar a que pase sola.
  • Se reduce la actividad física. Caminar y realizar actividades en general ayudan a generar las ondas musculares naturales que impulsan el movimiento de los contenidos intestinales. El reposo postoperatorio disminuye esta actividad.
  • Se ingiere menos comida y agua. La disminución del apetito, la menor cantidad de fibra en la dieta y el menor consumo de líquidos hacen que las heces se vuelvan más duras y tarden más en ser expulsadas.
  • El propio anestésico. La anestesia general ralenta temporalmente el funcionamiento intestinal; puede tardar uno o dos días en recuperar su ritmo normal.

Sumando todos estos factores, es muy común experimentar una sensación de lentitud o estreñimiento durante unos días. Es incómodo, pero en la mayoría de los casos no resulta peligroso.

El paso más importante: usar un laxante junto con los analgésicos fuertes

Si le han dado de alta con opioides o codeína, este es el mensaje clave: comience a tomar un laxante al mismo tiempo que los analgésicos, desde el primer día. No espere hasta que ya tenga estreñimiento y molestias para empezar. Dado que estos analgésicos ralentizan de forma constante el tránsito intestinal, lo más sensato es prevenir el problema en lugar de tratarlo después de que aparezca.

Su farmacéutico puede recomendarle un laxante de venta libre adecuado; una opción habitual es un estimulante suave como la senna, a veces combinada con un ablandador de heces (docusato). Tómelo regularmente mientras esté bajo tratamiento con analgésicos fuertes, no solo de forma puntual. Si le hemos recetado o sugerido un laxante específico, siga esas indicaciones.

La otra parte del mensaje es igualmente importante: reduca el uso de analgésicos fuertes en cuanto el dolor lo permita. A medida que el dolor disminuya durante los primeros días, pase de los opioides a opciones más sencillas como el paracetamol (y un antiinflamatorio, si se le ha indicado que es adecuado para usted). Cuanto menos opioides tome, menos se ralentizará su tránsito intestinal; dejar de usarlos es una de las mejores medidas que puede adoptar para su intestino y para su recuperación general. En nuestra página sobre el manejo del dolor y los opioides después de la cirugía encontrará más información al respecto.

Mantenga el tránsito intestinal activo: consejos básicos para el día a día

Además del laxante, algunos hábitos sencillos marcan una gran diferencia:

  • Beba abundante líquido. El agua que se consume a lo largo del día mantiene las heces blandas y favorece la acción del laxante. Esto es aún más importante si está tomando analgésicos.
  • Incorpore fibra a su dieta a medida que recupere el apetito. Las frutas y verduras, el pan y los cereales integrales, las legumbres y, en especial, las ciruelas o el jugo de ciruelas, son de gran ayuda. Una bebida tibia por la mañana también puede estimular el tránsito intestinal.
  • Muévase todo lo que le permitan. Incluso caminar suave y regularmente por la casa ayuda a activar el intestino. Respete los límites que le hayamos indicado tras la operación, pero evite permanecer sentado todo el día.
  • Responda rápidamente al impulso intestinal. Cuando sienta ganas de defecar, no las reprima y tómese el tiempo necesario. Un taburete para los pies que eleve ligeramente las rodillas puede facilitar la evacuación.

Un pequeño aviso: los suplementos de fibra formadores de masa (como el psyllium/Metamucil) no son la mejor opción en los primeros días tras la cirugía, especialmente si no bebe suficiente líquido, pues requieren mucha agua para actuar y, de lo contrario, pueden empeorar la situación. En esta etapa, la fibra proveniente de los alimentos y el uso del laxante mencionado anteriormente son opciones más seguras.

¿Qué es normal y cuándo hay que tener paciencia?

Es normal no evacuar durante un par de días después de una operación, sobre todo si se ha recibido anestesia y analgésicos fuertes. Es normal sentir hinchazón abdominal y lentitud intestinal; estos síntomas irán desapareciendo progresivamente al empezar a moverse, beber más líquidos, reducir el consumo de opioides y permitir que los laxantes hagan efecto. No hay motivo para preocuparse. La mayoría de las personas recuperan su patrón habitual en aproximadamente una semana.

Cuándo buscar ayuda: no espere

El estreñimiento suele ser más una molestia que un peligro, pero en ocasiones el intestino puede obstruirse de verdad o dejar de funcionar tras una cirugía (una afección conocida como íleo). Los signos de alerta que se detallan a continuación indican que debe consultar a un médico en lugar de seguir esperando.

Comuníquese con nosotros, con su médico de cabecera o con el servicio de urgencias más cercano si nota:

  • Ausencia de evacuaciones durante varios días junto con un abdomen hinchado, distendido y doloroso, especialmente si la situación empeora.
  • Náuseas o vómitos acompañados de incapacidad para defecar o para expulsar gases: esto puede indicar que el intestino está obstruido o ha dejado de moverse.
  • Dolor abdominal intenso o que empeora, o calambres.
  • Cualquier sangrado por el ano, o presencia de sangre en las heces.
  • Fiebre o sensación general de malestar, junto con cualquiera de los síntomas anteriores.

Si presenta varios de estos síntomas a la vez, sobre todo un abdomen hinchado y doloroso acompañado de vómitos, considere la situación como urgente y busque ayuda de inmediato. En el caso de un estreñimiento leve durante los primeros días, el plan basado en líquidos, fibra, ejercicio y laxantes descrito anteriormente casi siempre soluciona el problema. Si tiene dudas, llámenos. Preferimos recibir noticias suyas.


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